What is a defibrillator?
An implantable cardioverter defibrillator (ICD) is an electronic device that is implanted under the skin and is used to detect and treat dangerous heart rhythms called ventricular tachycardia or ventricular fibrillation. ICDs have been shown to prevent sudden cardiac death (cardiac arrest) in patients with certain types of life-threatening heart conditions such as congestive heart failure, hypertrophic cardiomyopathy, prior cardiac arrest, etc. An ICD looks similar to a pacemaker but is used to treat dangerously fast heart rhythms (pacemakers only treat slow heart rhythms). If a dangerously fast heart rhythm is detected, the ICD will deliver an internal electric shock (cardioversion or defibrillation) to the heart, restoring the normal heart rhythm and therefore preventing sudden death. In addition to regular ICDs, Dr. Ahuja also implants the subcutaneous ICD (S-ICD by Boston Scientific).
Why do you need an ICD?
ICDs are implanted in patients who are fortunate enough to have survived a prior cardiac arrest, or prophylactically in patients with dangerous heart conditions. Such conditions include ventricular tachycardia, ventricular fibrillation, congestive heart failure (CHF), hypertrophic cardiomyopathy (HOCM), Brugada Syndrome, Arrhythmogenic Right Ventricular Dysplasia (ARVD), or Long QT syndrome.
How do they work?
In general one (single chamber) or two (dual chamber) wires called leads are placed into the heart from a vein near the shoulder. The leads are then attached to an ICD that is permanently placed under the skin. The leads and ICD work together to monitor your heart rate all the time. If your heart rate becomes dangerously fast, the ICD will deliver an internal electric shock (cardioversion or defibrillation) to the heart, restoring the normal heart rhythm and therefore preventing sudden death.
You must have been fasting that day, and Dr. Ahuja will review pre-operative instructions and medications with you prior to the procedure. The ICD procedure is performed in the hospital in a sterile room called an electrophysiology lab (EP lab). The room is similar to an operating room. Nurses and anesthesiology will introduce themselves, and prep you for the procedure. After your shoulder area is prepared and cleaned under sterile conditions, mild conscious sedation and local anesthesia will be given near the shoulder. A small incision is then made near the shoulder so Dr. Ahuja can find the vein through which the leads will be inserted. The leads are then attached to an ICD, which will be placed under the skin and soft tissue. The position of the leads and ICD are checked in real time through an X-ray machine. The procedure takes a little less than an hour. Sutures are used that self-dissolve (nothing to remove later) and a mild glue is used on the superficial skin.
Recovery from surgery is relatively quick. Almost all patients are discharged home the next morning after spending one night in the hospital for observation and antibiotics. All post-operative instructions and appointments will be reviewed by Dr. Ahuja after the procedure. The ICD will then have to be checked periodically in the office 2-3 times per year.
Schedule a consultation
If you or someone you know has been told they need a defibrillator, contact Premier Cardiology Consultants at 516-437- 5600 to schedule a consultation with our electrophysiologist Dr. Ahuja.